Majority of doctors opposed to full access to your own electronic records

Technology is making transparency easier than ever, and with the advent of electronic medical records, you might think doctors and other caregivers would embrace transparency for patients. After all, in the US and most modern counties, you have the right to review your own health records.

Yet a recent survey by Harris Interactive, reported first at Computerworld, reveals that doctors aren't big fans of full transparency. A survey of 3,700 doctors in eight countries showed that only 31 percent believe that patients should have full access to their own medical records via electronic means. That's less than one in three. The majority of those surveyed, some 65 percent, supported "limited access," while the remaining 4 percent believe there should be no access granted to patients. So, despite the fact that we have rights to review and amend our records, doctors don’t want it to be easy for us to do so via electronic means.

I find these numbers incredibly disappointing, but they're not surprising. While there might be many motivations for wanting to deny patients full access to their medical records, I know firsthand one such motivation: these documents can be terribly inaccurate. Mistakes can run from the serious to the banal. Ars’ own Casey Johnston told me her medical records reported her birthdate incorrectly. Not a huge deal, but sort of a silly mistake to make.

I experienced something a little more serious. A few years ago I decided it was time to get some life insurance for me and my wife. Because we were seeking a significant policy, we were put through a fairly intense wringer, including a battery of medical tests conducted in our home and an extensive review of our medical records, in addition to multiple interviews. Through this process, I came to realize that my own medical records were littered with inaccuracies. For instance, the length of time that I had one specific condition had been significantly misstated. Another medical matter was listed that simply did not apply to me. Combined, these 2 issues could have cost me thousands of dollars over the course of the term of this insurance if I had not successfully resolved them. And this says nothing about how potential errors in records could lead to ineffective or even fatal treatment in an emergency situation.

What shocks me about all of this is the lack of concern online. The Internet took great umbrage at the likes of Twitter and Facebook before those companies liberated their users’ data. Why is it that we care more about getting access to our history of tweets than we do about getting electronic access to data about our personal health? In Massachusetts, doctors are given 3 weeks to respond to a request for a copy of patient records, and hospitals are given a full month. But in the world of electronic records, such access could be instantaneous.

Perhaps what is most irksome to me is that despite the lack of support for full access, 82 percent of those doctors surveyed do want patients to update their own records with regard to “demographics (95 percent), family medical history (88 percent), medications (87 percent) and allergies (85 percent),” according to the report. “And, the majority of doctors (81 percent) believe patients should even be able to add such clinical updates to their records as new symptoms or self-measured metrics, including blood pressure and glucose levels.” In other words, “please make our job easier to care for you, just don’t ask to see everything we are writing about you.”

In the end, the age of the godly doctor and the supplicant patient is coming to an end. It will likely take decades, but I wouldn't be surprised to see in my lifetime some iterative version of IBM's Watson occupying a corner of everyone's home, diagnosing and potentially treating a huge range of maladies. Artificial intelligence, nanotechnology, and the Internet (to just mention 3 major vectors) will converge to transform medical care and alter the meaning of what it is to be a doctor. Full and complete access to one's own medical history is a prerequisite to this progress, and doctors who stand opposed to it are ultimately standing in the way of progress.

Unfortunately, the survey did not expound on why doctors do not support full transparency via electronic medical records. Assuming a system is secure enough to allow users to add to their own electronic medical records, which most doctors do support, one would imagine that it should be secure enough to allow full viewing of the record. It's hard to imagine that information security lies at the root of this. If we're lucky, maybe some doctors will show up in the comments and let us know what's so bad about full transparency via electronic records.

Promoted Comments

Ken, I think this attitude is changing among many medical professionals, but it takes time. Physicians have generally had more fears about patients misunderstanding medical terminology & results and asking too many questions than what's actually happened in studies. I feel it's helpful for patients to review their records, since as you said, documentation errors happen, and it's important to correct these errors. Shoot, the financial and legal climate in medicine is such that many physicians put so much time in writing good, detailed notes that it's a shame if almost nobody reads them. Like you said, people have always had the right to access their records, but the trouble one needs to take for physical vs. electronic records is different.

However, sometimes easy access--because there really are people who will look at these records online, but wouldn't have gotten them on paper--does cause confusion. One example I can remember is that my patient say the term "renal failure" in a note, and disputed that she ever had it. She actually did--she was admitted once with acute renal failure that resolved with medical management--but the term caused confusion. Doctors have been advised to decrease use of potentially confusing acronyms, e.g. SOB for shortness of breath, due to the increased chance that their readers may not be in the medical field.

The CIO of BIDMC posted about an initiative to give patients access to their electronic medical record. Overall, I'd say their study alleviated some fears people had about what would happen when patients had increased access to their notes. Moving forward, my understanding is that things like radiology results which will get discussed soon in person at an actual appointment, there's a delay for things to appear online to patients still have the opportunity to be educated in person with their medical team about potentially confusing findings like small lung nodules, sclerotic changes, or benign masses. My future organization also has a patient gateway where patients can review their own lab & radiology results, so it seems like medical groups realize this is something patients care about.

163 Reader Comments

As a patient I would love to have full access... I could ad my own notes, correct any inaccuracies I spotted, use it as a reference. It would be awesome if it could be fully available to A&E people as well... you never know how a small nugget of info could change the treatment given in an emergency.

Sadly between doctors who like their little fiefdoms, people paranoid about privacy, invasive insurers, and the government style IT infrastructure it would require I don't see it happening in my lifetime.

My insurance company recently changed my gender - I was not a little surprised when a doctor's office challenged my credentials.

Different countries have very different ideas on transparency. German patients, for example, do not even care to know what is wrong. Of course cultural differences will slant an international survey. If such a survey is restricted to American physicians, the outcome will be different.

You can't correct inaccuracies spotted.You would have to find the inaccuracy, find the relevant party, tell them it's incorrect, probably provide some proof, and then get it fixed.

I would guess that one reason doctors wouldn't want full online access is because if lots of people suddenly did decide they want to correct their records, they would then have a massive flood of requests for information and changes to be put through.

You can't let someone change their historic medical records, and you have to segregate the doctor/medical professional input from the patient input as well, otherwise "Oh, no, I never smoked for 20 years and got pneumonia at some point as well. Please give me cheap health insurance because I'm in great health".

There's a lot more thought that needs to go into it other than "it would be awesome", because it would take a lot of time and money to set up, and then a lot of time and energy for every request which comes in relating to the records from the patient, which would all come at a similar time as suddenly everyone has access to their records.

It's a nice idea, but it's not as simple as "we should be able to do this and that and it would be easy to get things changed and simpler for everyone".

In the very long term, it would. But in the very long term all these doctors will have retired. No one wants to be the guy who has to deal with the transition.

Not a doctor, but I think I see right off the bat why doctors would be against this.

Self preservation. Or, at least career preservation. With full medical record access, it's only a short Google search away from the customers (oops, I mean "patients") to self-diagnosing, seeking more prominent physicians in the correlating field of ailment, alternative treatments like the homeopathic variety, choosing no treatment at all, etc.

Knowledge is power. Patient access to records shifts the balance of power. They and the HMO's would lose out on a lot of prescriptions and consultations.

What had immediately come to mind is the phrase, "Trust me, I'm a doctor."

One of my mom's eyes in in pretty bad shape. When she was a kid she had surgery on it, and really nothing changed. Fast forward decades to now and she decided she wanted to see if anything could be done about it.

She got a recommendation for an eye surgeon from a few different doctors who all said this one particular surgeon was one of the best in Cincinnati. So off she goes to see her. The surgeon tells my mom that it would be best to get her records from her surgery as a kid as it would be helpful, but they could still manage without it.

So my mom calls the office that has the medical records and they basically run her around for a few weeks. Long story short, my mom calls a lawyer and he calls to request the records for her. She was prepared to do what it took just on principle, but it's ridiculous.

Of course they don't want complete transparency of the records. You have to remember that medicine is a service industry, and _no_ service industry would be happy to have a customer's complete records exposed to said customer.

Just think about some of the things that might be in an IT support database about somebody, or a pizza delivery place: "guy is an asshole", "person keeps getting viruses from going to sketchy porn sites", "lousy tipper", etc.

Now take that sort of thing, and take it to the next level. Imagine you are a pediatrician, and a parent brings in a scraped and bruised kid "from a bike accident", but the bruises look a little suspicious to you. You may need to document something along the lines of "suspect child abuse. no family history, just keep an eye on this kid".

Or, in a different case, "possibly exhibiting drug seeking behavior".

What about "hypochondriac, self diagnoses illnesses they don't have".

If patients had access to things like that, it could severely damage patient relationships.

Limited access is a good thing. It allows people to be honest in their notes. Complete access makes service providers walk on eggshells and keeps them from doing their job to the best of their ability.

This is disappointing, as blackhex said having these available could only mean better treatment in the future, specially in cases of emergency. But I guess most members of the medical profession care more about money and protecting their own mistakes, not some sort of oath.

Once the more enlightened doctors and medical practices start advertising full access to your medical records online, it will become a real competitive edge. Those who don't allow access will be left behind. All it will take is one large medical group to take the lead on this and it should happen a lot faster than decades.

Easy access to that data would mean patients could carry around their medical data in a thumb drive and let other doctors have extremely fast and easy access to that data. Even if it has errors, it's better than nothing or waiting for the same data to be transferred from another hospital.

Well a couple of reasons I can think off from the top of my head is... not to make it too easy on hypochondriacs to complain loudly, not to make it too easy for people to figure out exactly what tests are being run so they can fake the right sort of symptoms to get whatever drugs they want, and generally to keep the general public in the dark about what kind of stuff goes in the journal that is often mostly meant to internally communicate hat kind of patient you are to other medical professionals, rather than have any bearing on your health.

Add to that the cover-your-own-ass reasons, that they just don't want to get called out on every little mistake they make by a certain category of people...

Oh, and of course imagine how many people would just be reading up their own journals and then coming back with the big but... "But google said..."

I agree that it would be cool to have open records electronically... but I can easily see why it's a difficult issue.

Simple reason doctors don't want full access - liability. The full medical record will show their misdiagnosis, mistakes and document symptoms reported that in hindsight could be interpreted as a failure to diagnose.

Your full medical record would be an attorney's wonderland. In fact, I could see a cottage industry sprouting up if full medical record access were mandated:

"Send us your records and our medical and legal experts will determine if your doctor has been doing his job. You may be owed money!"

...alternative treatments like the homeopathic variety, choosing no treatment at all, etc.

Knowledge is power. Patient access to records shifts the balance of power. They and the HMO's would lose out on a lot of prescriptions and consultations."

Why do people think they know enough about medicine to counteract what doctors tell them? If you are concerned about your course of treatment, get opinions _from other qualified medical professionals_. You don't have the years of training and experience required to make informed decisions on most things medicine related.

I imagine a large portion of their reticence is related to malpractice. That doesn't mean there isn't the traditional arrogance going on and whatall too.

My fiancee was in a major surgery and the surgeon, a decent guy, made an unavoidable mistake (we knew it was going to happen going in). I took him three minutes to admit that he was the one who made the mistake, and you could see that he made a heavy character judgment before doing so.

Since the survey didn't bother asking the Doctors "why not?" I can only guess that they see all the room for abuse. The author of this article cleared up errors and saved themselves thousands. With unguarded record keeping couldn't a less scrupulous person simply remove from their record any or all the things that would impact their costs? Or alters it to create a false paper trail to gain access to prescription drugs.-Those types of abuse even to lesser degrees would impact the Doctor's ability to perform their job. It adds the potential for a different sort of unreliability to the records by disrupting a sort of chain of custody on those records.

Coincidentally, at the moment there's a heated debate going on in the Netherlands about a national record system.The first version, started by the government was shot down eventually over security concerns. The second version, an altered system rebooted by the insurance companies themselves is getting the same scrutiny.

The general consensus is that in theory it'd be nice for the various medical professionals and the patients themselves to be able to view those records, but the potential for abuse is just too large.

Ken, I think this attitude is changing among many medical professionals, but it takes time. Physicians have generally had more fears about patients misunderstanding medical terminology & results and asking too many questions than what's actually happened in studies. I feel it's helpful for patients to review their records, since as you said, documentation errors happen, and it's important to correct these errors. Shoot, the financial and legal climate in medicine is such that many physicians put so much time in writing good, detailed notes that it's a shame if almost nobody reads them. Like you said, people have always had the right to access their records, but the trouble one needs to take for physical vs. electronic records is different.

However, sometimes easy access--because there really are people who will look at these records online, but wouldn't have gotten them on paper--does cause confusion. One example I can remember is that my patient saw the term "renal failure" in a note, and disputed that she ever had it. She actually did--she was admitted once with acute renal failure that resolved with medical management--but the term caused confusion. Doctors have been advised to decrease use of potentially confusing acronyms, e.g. SOB for shortness of breath, due to the increased chance that their readers may not be in the medical field.

The CIO of BIDMC posted about an initiative to give patients access to their electronic medical record. Overall, I'd say their study alleviated some fears people had about what would happen when patients had increased access to their notes. Moving forward, my understanding is that things like radiology results which will get discussed soon in person at an actual appointment, there's a delay for things to appear online to patients still have the opportunity to be educated in person with their medical team about potentially confusing findings like small lung nodules, sclerotic changes, or benign masses. My future organization also has a patient gateway where patients can review their own lab & radiology results, so it seems like medical groups realize this is something patients care about.

...alternative treatments like the homeopathic variety, choosing no treatment at all, etc.

Knowledge is power. Patient access to records shifts the balance of power. They and the HMO's would lose out on a lot of prescriptions and consultations."

Why do people think they know enough about medicine to counteract what doctors tell them? If you are concerned about your course of treatment, get opinions _from other qualified medical professionals_. You don't have the years of training and experience required to make informed decisions on most things medicine related.

Especially if you are talking about homeopathy. Wow.

"Why do people think they know enough about medicine to counteract what doctors tell them?" Because we're talking about people having full access to their records?

I agree, people should seek out experts, but since this thing called the internet, everybody's become an expert. People think they know more then the next guy. With limited medical access people already seek 2nd opinions (always a good idea), self diagnose, choose alternative treatments based on personal beliefs, and choose no treatment at all. What do you think people will do armed with full access?

"Limited access is a good thing. It allows people to be honest in their notes. Complete access makes service providers walk on eggshells and keeps them from doing their job to the best of their ability." - tenaku2You seemed to get it, then completely missed the boat. Information shifts the balance of power. What do you think the consequences are of people having full access to those "honest" notes are?

The same thing happened to my wife. One doctor had diagnosed her with a precondition of a disease but every subsequent test and doctor since has not once verified it. This led to an initial rejection of a life insurance policy which we had to go back and have corrected.

The word "transparency" is a wonderful fantasy word that seems to be a panacea for many people. Generally, though, it's a word that, like the phrase "network neutrality", seems laden with meaning and import but in actuality can mean very different things to different people. Much is dependent on your point of view.

In this case, the great bugaboo in modern medicine in the US is malpractice insurance. The expense of the premium is enormous. At the moment it is one of the most serious obstacles to a doctor opening his own practice--which is why we see so many doctors joining together in groups and hiring on to hospitals as salaried employees working in their various affiliated clinics. They cannot otherwise afford the malpractice insurance enabling them to practice. I'm not sure that doctors are so much opposed to their patients seeing what they write as they are opposed to their patient's lawyers being able to see what they write.

The other aspect of the situation is that often laymen try and diagnose themselves--the self-help medical genre in popular literature is robust. This is especially true for women and pregnancy--there are hundreds if not thousands of laymen-oriented pregnancy books readily available. Yet, self-diagnosis by the layman is one of the worst, most ignorant practices possible. The very best result of it is insomnia... In this vein, the fact is that most patients would understand very little of "what their doctor writes" and, not having attended medical school themselves, would often misunderstand the courses of treatment their doctor recommends. Lots of things in medicine sound completely irrational unless you understand the convoluted terminology employed... The amount of "second guessing" such transparency might entail would be little more than damaging both to physicians and patients alike.

Aside from all of that, patients can already request a copy of their records, anyway. How would putting those records on the Internet make them more "transparent" to the patient? The records instead might be made more transparent to other people aside from the patient, and I think that is a legitimate objection.

I am a doctor, and the first thing I would say is that this is not a very balanced report. It has a very strongly negative bias toward the outcome of the report and doesn't appear to have tried to seek an explanation from anyone involved.

Having said that - I myself would not support complete access to medical notes. It is easy to assume that since you are a rational person, everyone else is too. I have many patients who would have a very negative reaction to the honest comments in their notes - this would poison the relationship with their doctor and ultimately severely harm their medical care.

Medicine is not Facebook, or Twitter. Medicine is fundamentally personal, visceral and actually important. Different circumstances call for different rules. Complete transparency is not always in everyone's best interests.

"Why do people think they know enough about medicine to counteract what doctors tell them?" Because we're talking about people having full access to their records?

I agree, people should seek out experts, but since this thing called the internet, everybody's become an expert. People think they know more then the next guy. With limited medical access people already seek 2nd opinions (always a good idea), self diagnose, choose alternative treatments based on personal beliefs, and choose no treatment at all. What do you think people will do armed with full access?

"Limited access is a good thing. It allows people to be honest in their notes. Complete access makes service providers walk on eggshells and keeps them from doing their job to the best of their ability." - tenaku2You seemed to get it, then completely missed the boat. Information shifts the balance of power. What do you think the consequences are of people having full access to those "honest" notes are?

You say people have become experts because of the internet. But that's not really true if the information they're reading on the internet is wrong, or worse, propaganda for some nonsense like homeopathy.

I completely agree that it'd be great to give people access to this information, even the "honest" information so long as doctors are covered if the patient finds it offensive. However, I would not do it in our society today, due to poor education people lack the basic knowledge to evaluate their own treatment.

Simple reason doctors don't want full access - liability. The full medical record will show their misdiagnosis, mistakes and document symptoms reported that in hindsight could be interpreted as a failure to diagnose.

Your full medical record would be an attorney's wonderland. In fact, I could see a cottage industry sprouting up if full medical record access were mandated:

"Send us your records and our medical and legal experts will determine if your doctor has been doing his job. You may be owed money!"

This is an issue - they wouldn't even have to run after ambulances anymore.

Most complaints, and indeed most cases against doctors are based purely on misunderstandings. As a doctor watching the news I always have a facepalm ready for medical story reporting. Misunderstandings end up costing hospitals a tonne of money to defend, and cost doctors a tonne of time, grey hair and life-sappingly pointless time away from clinical medicine. Half-baked plans like this would likely leed to the most horrendous increase in just this kind of misunderstanding and would be grist to the lawyer's mill of blowing-things-out-of-all-proportion.

Slight correction, here... The doctors are not refusing people their records, they're refusing people to see the doctor's records. The doctor records his or her own opinions, observations, etc., about the patient. If you're a design house, a client doesn't have the right to demand all sketches you've made related to their work if its not in the contract. Obviously things are more sensitive because its health we're talking about, but remember these are the doctor's records on your case, not your records. The client does have certain rights and expectations, but it's not really as cut-and-dried as this article alludes.

Editor Moonshark says:

In the United States, patients have full rights to review their medical records, just not electronically.

The same thing happened to my wife. One doctor had diagnosed her with a precondition of a disease but every subsequent test and doctor since has not once verified it. This led to an initial rejection of a life insurance policy which we had to go back and have corrected.

Sounds like the perfect time for a second opinion. It's supposed to be common knowledge that anytime a doctor diagnoses a serious condition that a second opinion is sought. Most doctors recommend this, actually, as SOP. The greater danger, of course, is when your doctor diagnoses a very minor condition which turns out with the passage of time to have been a misdiagnosis of a serious or life-threatening disease, because the patient will not then see the benefit of a second opinion. (I had a friend who did not survive that unfortunate situation.) Obtaining a copy of your medical records, or having those records put on line, would do nothing to rectify that situation. Medical records are surely important, but the patient himself is far more critical to the process: no doctor is going to diagnose anything, or treat anything, that is indicated by medical records until he has seen the patient himself.

I am a doctor, and the first thing I would say is that this is not a very balanced report. It has a very strongly negative bias toward the outcome of the report and doesn't appear to have tried to seek an explanation from anyone involved.

Having said that - I myself would not support complete access to medical notes. It is easy to assume that since you are a rational person, everyone else is too. I have many patients who would have a very negative reaction to the honest comments in their notes - this would poison the relationship with their doctor and ultimately severely harm their medical care.

Medicine is not Facebook, or Twitter. Medicine is fundamentally personal, visceral and actually important. Different circumstances call for different rules. Complete transparency is not always in everyone's best interests.

I see your point. I think there is a case to be made for doctor's private notes, on the other hand anything that is viewable to an insurance company about me needs to be equally visible to me.

I am a doctor, and the first thing I would say is that this is not a very balanced report. It has a very strongly negative bias toward the outcome of the report and doesn't appear to have tried to seek an explanation from anyone involved.

Having said that - I myself would not support complete access to medical notes. It is easy to assume that since you are a rational person, everyone else is too. I have many patients who would have a very negative reaction to the honest comments in their notes - this would poison the relationship with their doctor and ultimately severely harm their medical care.

Medicine is not Facebook, or Twitter. Medicine is fundamentally personal, visceral and actually important. Different circumstances call for different rules. Complete transparency is not always in everyone's best interests.

Patients already can get their medical records from any doctor who complies with the law. Access electronically just makes it easier.

"Why do people think they know enough about medicine to counteract what doctors tell them?" Because we're talking about people having full access to their records?

I agree, people should seek out experts, but since this thing called the internet, everybody's become an expert. People think they know more then the next guy. With limited medical access people already seek 2nd opinions (always a good idea), self diagnose, choose alternative treatments based on personal beliefs, and choose no treatment at all. What do you think people will do armed with full access?

"Limited access is a good thing. It allows people to be honest in their notes. Complete access makes service providers walk on eggshells and keeps them from doing their job to the best of their ability." - tenaku2You seemed to get it, then completely missed the boat. Information shifts the balance of power. What do you think the consequences are of people having full access to those "honest" notes are?

You say people have become experts because of the internet. But that's not really true if the information they're reading on the internet is wrong, or worse, propaganda for some nonsense like homeopathy.

I completely agree that it'd be great to give people access to this information, even the "honest" information so long as doctors are covered if the patient finds it offensive. However, I would not do it in our society today, due to poor education people lack the basic knowledge to evaluate their own treatment.

Exactly. That is exactly what I'm saying. Perhaps I should have put the word in quotes or something; I was alluding to the fact that people only think they know what they are talking about ("experts") because they can do an internet search.It doesn't mean they are getting the right information, and I'm not advocating self-treatment. Just that full access to information shifts the balance of power.

I'm not a physician but I am far enough along in medical school to have some insight. First, let me tell you what does NOT factor into it-

-Errors. Physicians generally believe that they make few, if any, mistakes. Of course we all know that's complete crap, but it's how they think. Trust me, I've met many family doctors who've NEVER missed a cancer. So if physicians don't make errors, they aren't worried about you finding them.

-Malpractice. The patient can already request and get their medical records with sufficient ease to enable malpractice suits. It is hard to see any further easing of the process affecting this.

-Protecting their turf. Come on here, who really believes the internet will eliminate the need for physicians? I could care less if people fix their own dislocated shoulder using Google, gives me time to look at the more interesting issues. Some physicians are genuinely concerned that patients will misdiagnose themselves- this is a real possibility though granted a high quality diagnostic computer algorithm might one day be able to prevent. As for the poster who said patients might find out their condition can be treated homoeopathically- again, not a problem. Homeopathy is nothing more than a placebo, and it is difficult for physicians to ethically give placebos since by their nature they involve deception (making the patient believe they will work). But placebos really do make some people's lives better. So if finding them on the web works for you, all the better.

Here's what I think does factor in-

-Honesty. A lot of patients are in complete denial about their health. When a patient is dying, this goes up to about 90% at some point. As a med student, I am often sent in to assess a previously assessed patient and tested on my ability to figure out their issue. I always ask them why they are in the hospital (what easier way to get the answer than to just ask?). Well, as it turns out, they hardly ever know or talk about it. Patients forget to mention that they have incurable cancer and will be dead in a month. They don't tell me they had heart failure. The list goes on. Do we really want them to be able to edit out stuff like that? Along similar lines, nobody wants a psychiatric diagnosis, even if it is part of their problems. Now, best case opening up records could force physicians and patients to be more honest with each other and have more of the tough conversations. But worst case, patients will spend a huge amount of time complaining about the diagnosis they don't like. Finally, there could be things in there worry them unnecessarily. "Baby might have xyz" would freak out any new mother, and xyz might be some condition you think they only have a 1% chance of having.

-Safety. Some patient's have notes like "drug seker no narcotics" on their file. Now granted, you should always reassess the patient in case the note is wrong, but that note is there for the patient's safety. It needs to be there or they just hop from clinic to clinic until they get an overdose. And we don't want them coming after the physician who wrote that note either.

I support patient access, but we need to think about this to make room for honesty or quality of care will go down.

Having visited so many PCs that have "frozen," only to plug the mouse back in, I'm pretty certain that I don't want a world of self-updated medical records.

That said, I'd LOVE to be able to just see everything (you know, pertaining to me). Jam it all up in HealthVault and let me make charts and graphs. Of course, I have a bit of a data fetish.

I also wonder about the panic generated when Facebook data gets exposed here and there, and what that would look like if it happened with truly private data and not nonsense about what TV show you like.

Not a doctor, but I think I see right off the bat why doctors would be against this.

Self preservation. Or, at least career preservation. With full medical record access, it's only a short Google search away from the customers (oops, I mean "patients") to self-diagnosing, seeking more prominent physicians in the correlating field of ailment, alternative treatments like the homeopathic variety, choosing no treatment at all, etc.

Knowledge is power. Patient access to records shifts the balance of power. They and the HMO's would lose out on a lot of prescriptions and consultations.

What had immediately come to mind is the phrase, "Trust me, I'm a doctor."

You are a very good reason why patients should not be allowed instant access to their notes. You would become a self-styled expert, arguing every point to the death and end up dying of a stroke because, in the end you decided to drink dandelion water recommended to you by a high-school dropout instead of taking your fucking medication.

Slight correction, here... The doctors are not refusing people their records, they're refusing people to see the doctor's records. The doctor records his or her own opinions, observations, etc., about the patient. If you're a design house, a client doesn't have the right to demand all sketches you've made related to their work if its not in the contract. Obviously things are more sensitive because its health we're talking about, but remember these are the doctor's records on your case, not your records. The client does have certain rights and expectations, but it's not really as cut-and-dried as this article alludes.

This. Yes, there are some instances where giving the patient full access to the medical record could make the situation worse. For example, if the doctor suspected Münchausen syndrome or a drug seeking patient and the patient knew immediately, they would just jump to the next doctor. It's important that doctors document these things for legal purposes, but it does not benefit the patient to know.

I think it makes a lot of sense to give patients some access to the medical record, but not complete access--with complete access the patient will do their best research online and try to manage their own care, which could be disastrous.

I am a doctor, and the first thing I would say is that this is not a very balanced report. It has a very strongly negative bias toward the outcome of the report and doesn't appear to have tried to seek an explanation from anyone involved.

Having said that - I myself would not support complete access to medical notes. It is easy to assume that since you are a rational person, everyone else is too. I have many patients who would have a very negative reaction to the honest comments in their notes - this would poison the relationship with their doctor and ultimately severely harm their medical care.

Medicine is not Facebook, or Twitter. Medicine is fundamentally personal, visceral and actually important. Different circumstances call for different rules. Complete transparency is not always in everyone's best interests.

Patients already can get their medical records from any doctor who complies with the law. Access electronically just makes it easier.

Ken Fisher / Ken is the founder & Editor-in-Chief of Ars Technica. A veteran of the IT industry and a scholar of antiquity, Ken studies the emergence of intellectual property regimes and their effects on culture and innovation.